Tender no: T&C/AR/03/R-2103
ANNEXURES, APPENDICES AND
DEVIATION STATEMENT TO BE FILLED
UP & UPLOADED BY THE BIDDERS
Tender no: T&C/AR/03/R-2103
ANNEXURE – III
-: DECLARATION BY THE BIDDER :-
I _________________________________________________ representing the bidder, do declare on
behalf of the firm as hereunder:
* That, I am the PROPRIETOR of the bidder firm. I undertake to submit proof of
ownership as and when demanded by NALCO.
OR
* That I am the authorized signatory to the tender documents holding valid Power of
Attorney. Certified copy of the valid power of Attorney is enclosed with
offer.
NOTE:* Strike out whichever is not applicable.
(a) That, we do not have any FINANCIAL/ PROFESSIONAL stake in any of the other bidders
participating in this tender;
(b) That, this firm has not been blacklisted/ debarred/ banned in any unit of NALCO/ Other PSUs
/ GOVTs of India/ states.
(c) That, we have never been prosecuted by any statutory authority.
(d) That, any change in the constitution of the firm shall be made with prior clearance from
Nalco.
(e) That, we have studied all the clauses/sub-clauses terms and conditions of the tender
documents and our offer fully comply with the requirements spelt out in the tender
documents.
(f) We undertake to abide by and comply with all the safety and environmental regulations in
force during the execution of work.
(g) We undertake to abide by and comply with all the applicable provisions of laws governing
contract workers engaged by you for this work.
(h) The appendix I & II regarding relatives working in NALCO are filled up and enclosed.
(i) That we have quoted the rates in figures as well as words.
(j) We undertake that we do not have any unauthorized structure / construction inside Nalco
Township or Plant. We also undertake to remove any / all such structures, if detected by
Nalco later on in compliance of GCC terms and conditions.
(k) We declare that all supporting documents of the offer submitted are attested by a gazetted
officer / Notary.
(l) I/we declare that I/we have not been convicted / or any case has been initiated against
me / us by a Court of Law or indictment / adverse order by a regulatory authority against
me / us, or my / our company or against any sister concern of mine / ours which relates to
a criminal offence.’’
I further declare that all above statements are true and if found otherwise any time during pre-
ordering/post ordering stage of the contract, action as deemed fit by NALCO including ‘rejection of
my offer’ and ‘debarring/blacklisting’ may be taken against me/my firm / my company and shall be
binding on me/ firm / my company represented by me.
Signature and official seal of the Proprietor / Authorised Person)
Date : Name of the signatory………………………………
Postal address of the firm--------------------------------
------------------------------------------------------------------
PAN NO : TIN NO :
PF NO : ESI NO :
GSTIN:
Phone No………………… Mobile No……………Fax No...................
Email Address :
Page 1 of 8 Signature & Seal of the bidder with date
Tender no: T&C/AR/03/R-2103
ANNEXURE-V
INTERNET BANKING / R.T.G.S. BANKING MANDATE FORM
(To be submitted in Duplicate)
To
National Aluminium Company Limited,
M&R complex,
Damanjodi-763008
Dear Sir,
SUB: AUTHORISATION FOR RELEASE OF PAYMENT DUE FROM NALCO, M&R COMPLEX
THROUGH INTERNET BANKING (SBI) OR THROUGH R.T.G.S. BANKING.
Refer Order No………………………..…………… date……………………. and/ or Tender/ Enquiry/ Letter
No……………………………….…………….…….. date…………………….
(Please fill in the information in CAPITAL LETTERS. Please TICK wherever it is applicable)
1. Name of the Party. : ……………………………………………………………………………..........
2. Address of the Party. ……………………………………………………………………………..........
……………………………………………………………………………............
City………………........................... Pin Code
E-mail Id:
3. Particulars of Bank:
Bank Name Branch Name
Branch Place Branch City
Pin Code Branch Code.
MICR No.
(9 Digits code number appearing on the MICR Band of the cheque supplied by the Bank. Please attach Xerox copy of a
cheque of your bank for ensuring accuracy of the bank name and code number)
Account Type Savings Current Cash Credit
Account Number (as appearing
in the Cheque Book)
R.T.G.S. IFSC Code.
4. Date from which the mandate should be effective: Dt. / /20........
I/we hereby declare that the particulars given above are correct and complete. If any
transaction is delayed or not effected for reasons of incomplete or incorrect information, i shall not
hold m/s national aluminium company limited responsible. I also undertake to advise any change in
the particulars of my account to facilitate updating of records for purpose of credit of amount through
RBI ECS/ RBI EFT/SBI net.
Place: Signature of the party/ Authorized Signatory.
Date:
---------------------------------------------------------------------------------------------------------------------------
Certified that particulars furnished above are correct as per our records.
Bank’s Stamp:
Date:
(Signature of the Authorized Official from the Bank)
Page 2 of 8 Signature & Seal of the bidder with date
Tender no: T&C/AR/03/R-2103
ANNEXURE-VI
Undertaking Letter on Downloaded tender documents
We here by confirm that, we have downloaded the complete set of tender
documents along with the set of enclosures hosted in www.eprocure.gov.in. We
confirm that the bid document has not been edited or modified by us. In case, it is
observed by NALCO that the bid document has been edited or modified, we agree
for the rejection of the bid by NALCO besides any action as deemed fit by NALCO.
Company Name __________________________________________________________________________
Name ______________________________________________________________________________________
Signature _____________________________________________ Date _____________________________
Postal Address ___________________________________________________________________________
Email ID ___________________________________________________________________________________
Phone _________________________________________________ FAX ______________________________
Signature of Authourised Person With seal
Page 3 of 8 Signature & Seal of the bidder with date
Tender no: T&C/AR/03/R-2103
ANNEXURE-VII
EXCEPTION / DEVIATION STATEMENT TO THE TENDER TERMS & CONDITIONS
In case of no deviation please write 'No Deviation' in the space below :
In case of single part bidding no deviation is acceptable.
Sl. Reference of Tender Document Subject Deviation /
No Page No. Clause No. Para No. Exception
Page 4 of 8 Signature & Seal of the bidder with date
Tender no: T&C/AR/03/R-2103
APPENDIX – I
NATIONAL ALUMINIUM COMPANY LIMITED.
Alumina Plant
INSTRUCTION FOR BIDDERS: FILLING UP OF FOLLWING APPENDICES IS MUST, WITHOUT WHICH
THE OFFER IS LIABLE FOR REJECTION.
The tenderer shall carefully study the list of directors of NALCO given below and state “Yes” or “No”
to questions given below:
Sl.No Name Sl.No Name
Part Time Official Directors
1. Shri S Patra, CMD 6. Dr N K Singh
2. Shri V.Balasubramanyam, D(P) & D(F)I/C 7. Shri Subash Chandra
3. Shri R Mohapatro, D (HR)
4. Shri S.K.Roy, D (P&T) Part Time Official Directors
5. Shri P K Mishra, D (C) 8. Prof. Damodar Acharya
9. Shri Dipankar Mohanta
10. Shri Maheswar Sahu
11. Shri S. Sankararaman
12. Shri P K Nayak
13 Smt. Kiran Ghai Sinha
Sl.No. Description Write “Yes” or “No”
1. Whether the tenderer is a relative of any of the directors of NALCO?
2. If the tenderer is a firm, any of NALCO Directors or any of their relatives
is a partner in the tender’s firm?
3. If the tenderer is a Company Registered under Company’s Act 1956,
whether any of NALCO’s Directors is Director of the Company?
Note: If Yes to any of the above questions, please give the name of NALCO’s Director and
relationship of the tenderer / partner / member / Director as the case may be.
Sl.No. Name Relationship
Page 5 of 8 Signature & Seal of the bidder with date
Tender no: T&C/AR/03/R-2103
APPENDIX – II
Important : Suppression of information shall be viewed seriously and action deemed fit would be
taken including termination of the contract.
(Strike out which is not applicable)
1. I/We hereby declare that none of my/our relative is an employee of NALCO.
2. I/We hereby declare the following are the employee/s of NALCO is/are my/our relative/s.
Sl.No. Name of the employee/ P.No. / Designation/Place of Posting. Relationship with the employee.
1
(PLEASE ATTACH EXTRA SHEET, IF REQUIRED)
Page 6 of 8 Signature & Seal of the bidder with date
Tender no: T&C/AR/03/R-2103
APPENDIX – III
DETAILS OF PRESENT COMMITMENTS OF THE TENDERER
NAME OF TENDERER
Sl. Full postal Address of Description of Value of Date of Schedul State Expecte Remark
No client & Name of work contract commen ed compl d date s
Officer-in-Charge cement Complet etion of
with telex / of work ion in % complet
Telephone NO. period as on ion
date
1 2 3 4 5 6 7 8 9
Documentary proof for above information enclosed.
Page 7 of 8 Signature & Seal of the bidder with date
Tender no: T&C/AR/03/R-2103
APPENDIX - IV
PROPOSED SITE ORGANISATION
NAME OF TENDERER:
Tenderer is to indicate here the site organization, he proposes to set up for execution of the work.
It is understood that this will be augmented from time to time depending on the requirements for
timely completion of the work as directed by the Engineer-in-Charge.
Tenderer is also to furnish the bio-data of the Resident Engineer & key personnel to be deployed at
site.
Signature Not Verified
Digitally signed by KUTISWAR BISWAS
Date: 2020.09.08 11:33:00 IST
Page 8 of 8 Location:
Signature & Seal of the eProcure-EPROC
bidder with date
